Raman Interferometry between Autoionizing States to Probe Ultrafast Wave-Packet Dynamics with High Spectral Resolution.

Photoelectron interferometry with femtosecond and attosecond light pulses is a powerful probe of the fast electron wave-packet dynamics, albeit it has practical limitations on the energy resolution. We show that one can simultaneously obtain both high temporal and spectral resolution by stimulating Raman interferences with one light pulse and monitoring the modification of the electron yield in a separate step. Applying this spectroscopic approach to the autoionizing states of argon, we experimentally resolved its electronic composition and time evolution in exquisite detail. Theoretical calculations show remarkable agreement with the observations and shed light on the light-matter interaction parameters. Using appropriate Raman probing and delayed detection steps, this technique enables highly sensitive probing and control of electron dynamics in complex systems.

Improvements to the calibration of the MST Thomson scattering diagnostic.

Calibration of the Madison Symmetric Torus Thomson scattering system has been refined to improve temperature fluctuation measurements. Multiple avalanche photodiodes have been directly calibrated for use as reference detectors during calibration, improving accuracy and ease of use. From the absolute calibration we calculate corrections to the gain for variation in detector operating temperature. We also measure the spatial uniformity of detector responsivity for several photodiodes, and present a method of accounting for non-uniformity in the calibration process. Finally, the gain and noise enhancement are measured at multiple wavelengths to improve temperature and uncertainty measurements.

Supraclavicular continuous peripheral nerve block in a wounded soldier: when ultrasound is the only option.

The complex nature of combat-related injuries requires frequent operative interventions and prolonged analgesic therapy. The application of continuous peripheral nerve block (CPNB) has been an important anaesthetic tool in the management of combat soldiers wounded from the current conflicts. The severe, destructive nature of combat injuries makes placement of CPNB difficult or impossible using more common neurostimulation approaches. The use of ultrasound technology has improved our success in placing CPNB in the presence of such injuries. We report the application of ultrasound technology in placing CPNB in a combat-injured soldier, whose injuries precluded other CPNB options.

The frequency of common skin conditions in preschool-age children in Australia: atopic dermatitis.

OBJECTIVE: To determine the prevalence and severity of atopic dermatitis in a stratified cross-section of preschool-age children examined throughout Victoria, Australia. DESIGN: A cross-sectional skin survey using a selected cluster sample of the various centers throughout Victoria. SETTING: The study population included Victorian children attending child-care centers, preschools, and Maternal and Child Health Centres, with the reference population being Australian children aged 5 years and younger. PARTICIPANTS: Of 1634 potential participants, 1116 children (68.3%) were examined. INTERVENTION: A dermatologist performed a total skin examination, including head and neck, limbs, and trunk, on all children. The diaper area was examined in children younger than 12 months. MAIN OUTCOME MEASURE: All parents were administered a questionnaire to elicit demographic information, history of skin conditions, and family history of skin problems or related diseases. The examiner recorded the presence, site, and severity of atopic dermatitis for calculation of age- and sex-specific prevalence rates. RESULTS: The age- and sex-adjusted point prevalence was 30.8% (95% confidence interval [CI], 28.0%-33.5%). Most children (63.7%) were classified as having minimal or mild disease. Only 5.8% of children with atopic dermatitis did not have face or flexural involvement. Of the 237 children with atopic dermatitis and information available, 209 used 1 or more products to treat their condition. CONCLUSIONS: Atopic dermatitis is common, decreasing in prevalence after the first 3 years of life. Most children have mild disease requiring little if any treatment, and much could be prevented with simple measures. Educational programs directed at those caring for preschool-age children that provide information on simple preventive measures, where practical, and sources of advice for treatment, if necessary, could substantially reduce the morbidity of this condition in predisposed children.

Suicide risk following child sexual abuse.

OBJECTIVE: To determine the suicide rate and prevalence of suicide attempts and suicidal ideation in 183 young people who had experienced child sexual abuse and to examine variables related to the abuse, which may correlate with suicide attempts or suicidal ideation. METHODS: Adolescents and young adults who had experienced child sexual abuse and individuals from a nonabused comparison group were asked about suicide attempts and suicidal ideation 5 and 9 years after intake to the study. Nine years after the abuse, a national death search was carried out to ascertain the number and causes of death in the 2 groups. Logistic regression was used to assess information on demographic and family functioning variables, the sexual abuse, notifications for other child abuse, criminal convictions, and out-of-home placements that were related to the outcome variables. RESULTS: Young people who had experienced child sexual abuse had a suicide rate that was 10.7 to 13.0 times the national Australian rates. There were no suicides in the control group. Thirty-two percent of the abused children had attempted suicide, and 43% had thought about suicide since they were sexually abused. CONCLUSIONS: Little information seems to be available to clinicians at the time of investigations for child sexual abuse in children that may identify those who are at increased risk of suicide. Abuse by an acquaintance, parental denial, or being angry with the child and not the abuser may predispose to suicide attempts but not necessarily to a completed suicide.

Population-based surveys on the frequency of common skin diseases in adults--is there a risk of response bias?

Population-based surveys on the frequency of common skin diseases are important in determining the health needs of a community. As they rely on voluntary presentation, there is a risk of response bias which may compromise the quality of the data obtained. The aim was to determine in what way and to what degree response bias may occur in a population-based survey on the frequency of common skin diseases in adults. A follow-up study was conducted on 1043 out of 2500 adults who did not attend for examination as part of a randomized population-based survey on the frequency of common skin diseases amongst adults in Maryborough, Central Victoria, Australia. Nonrespondents were more likely to be at the extremes of age, retired, unemployed and less likely to report that they had a history of skin disease than the respondents. Subsequent examination of a sample of the nonrespondents revealed they were more likely to have skin cancers and Campbell de Morgan angiomas than the respondents. These differences cannot be fully explained on the basis of an age-related response bias alone. Response bias is a risk in population-based surveys of common skin diseases which rely on voluntary presentation. Some attempt should be made to sample the nonrespondents in these surveys to determine the nature and extent of any bias and to adjust for it, if necessary.

The prevalence of common skin conditions in Australian school students: 4 Tinea pedis.

Tinea pedis is a condition that is common, often undiagnosed and frequently inadequately treated. It is reported as being rare in young children, but there are relatively few population-based reports of prevalence. A randomized sample of 2491 students from schools throughout the State of Victoria, Australia, were examined by dermatologists and dermatology registrars, who recorded clinical signs suggestive of tinea pedis, which were then confirmed by fungal culture. The age- and sex-adjusted prevalence of culture-proven tinea pedis was 5.2% [95% confidence interval (CI) 3.58-6.82] increasing with age from 2.1% (95% CI 0.95-3.28) in 4-6 year olds to 9.7% (95% CI 5.21-14.26) in 16-18 year olds. A higher proportion of males (6.0%) had tinea pedis than females (4.3%). Trichophyton mentagrophytes and T. rubrum were the most common dermatophytes isolated on culture. Less than 40% of those with a positive diagnosis had reported on the questionnaire that they had tinea. Of those who reported correctly that they had tinea, 75% had used one or more products to treat their condition, of which more than 40% were classified as unlikely to have any therapeutic effect on tinea pedis. These data confirm that tinea pedis, a potentially transmissible disease, is common in Australian schoolchildren, including those in primary school. There is a need for education programmes in schools on the nature of tinea pedis, the treatment available, and the public health approach to infection control within the school and home environment.

The prevalence of common skin conditions in Australian school students: 2. Atopic dermatitis.

The prevalence of atopic dermatitis (AD) was recorded following examination by dermatologists and dermatology registrars of a random sample of 2491 school students throughout the State of Victoria, Australia. The overall prevalence, based on clinical examination, was 16.3% (95% confidence interval, CI 14.1-18.5), being higher in girls (17.7%; 95% CI 15.0-20.4) than boys (14.8%; 95% CI 11.8-17.8). Using the U.K. Working Party Diagnostic Criteria for AD reduced the prevalence to 10.8% (95% CI 9.3-12.3) with the prevalence in girls 12.3% (95% CI 10.1-14.4) and in boys 9.2% (95% CI 7.1-11.4). The prevalence was highest in 4-6 year olds (18.7% on clinical examination, 11.5% using the U.K. Working Party Criteria), decreasing with increasing age to 11.6% on clinical examination (8. 6% on U.K. Working Party Criteria) among 16-18 year olds. Most of those with AD were classified as having mild disease (54.1%), with 32.1% classified as having minimal and 13.8% as having moderate to severe disease. Over 80% of those who reported on the questionnaire that they had dermatitis that was then confirmed on examination had been using one or more products to treat it. Nearly 90% of these products were classified as efficacious, with medical practitioners being the major source of advice for their use (77%). Pharmacists (8%), family/friends (6%) and others (9%), including beauticians and naturopaths, made up the remainder of the persons from whom those affected had sought advice about their treatment. These data, the first community-based prevalence data on AD published from Australia, confirm that the condition is common among those of school age. There is a need for AD to be included among those conditions that are discussed in health education lessons in schools.

The frequency of common nonmalignant skin conditions in adults in central Victoria, Australia.

BACKGROUND: Nonmalignant skin conditions are believed to be common in adults, although there are very few community-based studies to determine their exact frequency. OBJECTIVE: To record the prevalence of common, nonmalignant skin conditions in adults in central Victoria, Australia. METHODS: A total of 1457 respondents from a random selection of adults aged 20 years and over from Maryborough, central Victoria, were given a total body examination by a dermatologist or dermatology trainee. People with any nail or skin signs suggestive of tinea had scrapings taken for fungal culture. RESULTS: The age- and sex-adjusted prevalence of warts was 7.1% (95% confidence interval (CI), 5.8-8.4%), acne 12.8% (95% CI, 11.0-14.5%), atopic dermatitis 6.9% (95% CI, 5.6-8.3%), seborrheic dermatitis 9. 7% (95% CI, 8.2-11.2%), asteatotic dermatitis 8.6% (95% CI, 7.1-10. 0%), psoriasis 6.6% (95% CI, 5.7-7.9%), culture-positive tinea 12% (95% CI, 10.3-13.6%), seborrheic keratoses 58.2% (95% CI, 55.6-60. 7%), and Campbell de Morgan spots (cherry angiomas) 54.4% (95% CI, 51.9-57.0%). There was variation in the prevalence of many of these conditions with age. CONCLUSIONS: This study demonstrates that nonmalignant skin conditions are common in adults in Australia. Their diagnosis and management represent a considerable burden not only to those suffering from the conditions, but also to the health system which provides for their care.

A review of the epidemiology of psoriasis vulgaris in the community.

Standard diagnostic criteria for epidemiological studies of psoriasis are currently lacking. In their absence, clinical examination and diagnosis of psoriasis by dermatologists provides the gold standard to underpin epidemiological research in psoriasis. The methods of data collection used most frequently include cross-sectional studies, case-control studies, cohort studies, and surveys of hospital and private practice attendance. Estimates of psoriasis prevalence made in cross-sectional studies employing clinical examinations as the survey instrument have ranged from 0.3 to 2.5%. Psoriasis incidence has been estimated at 60.4 per 100,000 person years in one cohort study. Several factors have been identified as being associated either with causation of psoriasis or with triggering exacerbations or remissions, including genetic determinants, racial and regional variation, injury and infection, cigarette smoking, alcohol, diet and other diseases.

The prevalence of common skin conditions in Australian school students: 3. acne vulgaris.

The prevalence, severity and disability related to facial acne (comprising acne on the head and neck) was assessed in a randomized sample of 2491 students (aged 4-18 years) from schools throughout the State of Victoria in Australia. Students were diagnosed clinically by a dermatologist or dermatology registrar. The overall prevalence (including 4-7 year olds) was 36.1% (95% confidence intervals, CI 24.7-47.5), ranging from 27.7% (95% CI 20.6-34.8) in 10-12 year olds to 93.3% (95% CI 89.6-96.9) in 16-18 year olds. It was less prevalent among boys aged 10-12 years than girls of the same age; however, between the ages of 16 and 18 years, boys were more likely than girls to have acne. Moderate to severe acne was present in 17% of students (24% boys, 11% girls). Comedones, papules and pustules were the most common manifestations of acne, with one in four students aged 16-18 years having acne scars. Twelve per cent of students reported a high Acne Disability Index score. This tended to correlate with clinical severity, although there was some individual variation in perception of disability. Seventy per cent of those found to have acne on examination had indicated in the questionnaire that they had acne. Of those, 65% had sought treatment, a substantial proportion of which (varying with who gave the advice) was classified as being likely to have no beneficial effect. This is the first population-based prevalence study on clinically confirmed acne published from Australia. The results show that acne is a common problem. They suggest the need for education programmes in schools to ensure that adolescents understand their disease, and know what treatments are available and from whom they should seek advice.

Difficulties experienced by carers from non-English-speaking backgrounds in using health and other support services.

The proportion of the Australian population from non-English-speaking backgrounds is increasing (particularly among the elderly, who are more likely to be disabled), but their use of health care services and institutions is proportionately lower than that for other Australians, and many care for a family member with a disability or illness at home. The study objective was to document the experiences of such carers in using health and other support services in order to understand the reasons for underutilisation. This study differs from most other carer studies in concentrating on carers with little or no English, and by using a semistructured interview that enabled carers to describe their experiences and attitudes more openly. Forty women carers were interviewed, with bilingual interviewers or interpreters being used where necessary. Interviews were tape-recorded and content-analysed. The services used, sources of information and referral, and the reasons for not using a service were identified. Some of the difficulties experienced in using services were common to many carers, irrespective of background, whereas others related specifically to English language deficits and cultural differences. Carers were reluctant to institutionalise a family member, despite their own health problems, emphasising the need for greater support from existing and expanded services to enable the relative to be cared for at home.

The potential benefits and harms of screening for colorectal cancer.

Australian guidelines for colorectal cancer screening for average-risk populations vary from recommendations for annual screening by faecal occult blood testing for those over 40 years to recommendations that screening may be appropriate if requested by an informed patient aged 50 to 75 years. There are five large screening trials, of which three have published mortality data. A meta-analysis of the mortality data suggests a 19 per cent reduction in colorectal cancer mortality (95 per cent confidence intervals 0.68 to 0.96) with Hemoccult screening. Because of the width of the confidence interval, decisions about the magnitude of the effect of screening should await further trial results, which should be available in the next few years. In the interim, we should examine issues of harm and costs in Australia. For example, in the major trials, over 80 per cent of positive results have been falsely positive and have required invasive investigation. Estimates of the cost-effectiveness of screening for the Australian health system are not yet available and are essential. If the benefits of screening outweight the harms and costs, a successful screening program would require provision of screening infrastructure and appropriate information to target populations, quality control for screening tests and investigations, recall mechanisms to ensure appropriate follow-up of persons with positive results and the active participation of the Australian public and health practitioners.

Methodological considerations in research on child sexual abuse.

Child sexual abuse research presents practical, methodological and statistical challenges. This paper examines some recent literature about the incidence and effects of child sexual abuse. Researchers who use epidemiological studies to attempt to ascertain the prevalence of different forms of abuse should be aware of the different populations studied, different methodologies used, diverse definitions of sexual abuse and practical limitations on participants' memories. Common problems in retrospective and prospective studies into the effects of child sexual abuse include the use of atypical populations, inappropriate statistical analyses, the use of unvalidated psychometric instruments and limited sources of information on child functioning. Attention must also be paid to potentially confounding demographic and family variables. A thorough understanding of, and attention to, these problem areas in child sexual abuse research will give a clearer picture of the prevalence and effects of abuse, thus indicating the most appropriate forms of prevention and treatment.

Reproductive health counseling for young men: what does it do?

A reproductive health intervention combining a highly explicit half-hour slide-tape program with a personal health consultation was provided to male patients aged 15-18 at a large health maintenance organization. A test of the consultation's impact against a control group provides no support for the argument that highly explicit instruction in contraception encourages early initiation of intercourse. In fact, the consultation may have reduced pressure to become sexually active among young men who had never had sexual intercourse. There is also some evidence that the consultation helped improve the effectiveness of contraceptive practice among the men who were sexually active at follow-up; those exposed to the consultation were more likely than those who were not to report that their last intercourse was protected by the pill and that their main method of contraception in the previous year was the pill. Compared with those in the control group, patients who received the health consultation scored higher on measures of fertility knowledge and knowledge of the prevention of sexually transmitted diseases, including AIDS. Furthermore, the young men who had the consultation were more likely to have practiced testicular self-examination. In many cases, however, the positive effects of the consultation were stronger or were only statistically significant among those who had not been sexually active at the time of the baseline survey.

PIP: This case-control study examined the effects of a reproductive health intervention directed to 15-18 year old adolescent male members of a US health maintenance organization. The intervention combined an explicit slide-tape program with a personal health consultation designed to improve contraceptive practice and knowledge of fertility, prevent sexually transmitted diseases, increase the practice of testicular self-examination, and ameliorate coercive sexual attitudes. Comparison with controls revealed that the intervention did not encourage early initiation of intercourse but may, in fact, have reduced pressure to become sexually active. There was some evidence at follow-up that the intervention improved the effectiveness of contraceptive practice among the men who were sexually active. Cases scored higher than controls on measures of knowledge in the subjects covered by the intervention. The intervention had the greatest impact on young men who were not sexually active at the time of the baseline survey. This implies that additional efforts should be directed to young men who are already sexually active and use contraceptives in an inconsistent manner (or not at all). The breadth of the topics covered in the intervention and the use of audiovisual materials are possible reasons for its success.